tbuckley/cabot-search huggingface dataset:
Abstract 10115: Unique Imaging Morphology and Rare Location of Papillary Fibroelastoma Resulting in a Cardioembolic Stroke
Authors: Nazeera Ghanie, Nodari Maisuradze, Ram Prakash Thirugnanasambandam, Nicholas Taklalsingh, Suzette Graham-Hill
Journal: Circulation (2022)

Clinical Presentation: Afro-Caribbean female, age 59, with a comorbidity of hypertension presented with acute painless right-sided vision loss. Brain MRI revealed numerous scattered T2/FLAIR hyperintense foci throughout the periventricular, deep, and subcortical white matter, which were favored to represent chronic microvascular ischemic changes. CTA of the head and neck demonstrated mild atherosclerotic calcification of the cavernous segment of the left internal carotid artery without significant stenosis, mild noncalcified atherosclerotic plaque at the right carotid bifurcation, and mild irregularity and narrowing of the mid basilar artery. Cardiac Imaging: Transthoracic Echocardiography (TTE) demonstrated severe concentric left ventricular hypertrophy, left ventricle ejection fraction 60-65%, and a mobile, intracavitary mass measuring 1.60cm x 1.59cm. Repeat TTE estimated the mass to be 1.8cm x 1.2cm in the region of the posteromedial papillary muscle. Transesophageal Echocardiography (TEE) redemonstrated a mobile left ventricular mass measuring 2.0cm x 1.8cm along the inferior wall of the interventricular septum. Left heart catheterization demonstrated nonobstructive coronary artery disease with a 30% stenosis of the proximal Right Coronary and Distal Circumflex. Patient underwent surgical removal of the cardiac mass, biopsy-proven to be a Papillary Fibroelastoma (PFE). Discussion: PFEs account for 7.9% of all primary benign cardiac tumors and are the most common valvular tumor. More than 80% of these tumors are attached on the aortic or mitral valve, unlike in this patient where it was attached to the left ventricular trabeculae without involvement of the mitral valve or sub-valvular apparatus. The classic appearance of PFEs on TTE is pedunculated and often compared to a sea anemone but appeared homogenous in nature with central vacuolization in this case. This made characterizing the mass as a thrombus or cardiac tumor challenging.
Abstract 10190: Recurrent Pulmonary Hypertension After Balloon Pulmonary Angioplasty in Patients With Inoperable Thromboembolic Pulmonary Hypertension
Authors: Ryo Takano, Tatsuo Aoki, Ryotaro Asano, Jin Ueda, Akihiro Tsuji, Takeshi Ogo
Journal: Circulation (2022)

Backgrounds: Balloon pulmonary angioplasty (BPA) improves hemodynamics and prognosis in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Though it has been reported that recurrent pulmonary hypertension (PH) after pulmonary endarterectomy is rare, the recurrence rate of PH after BPA remains to be clarified. In this study, we examined the frequency of recurrent PH after BPA in the long-term period and the risk factors. Methods: We retrospectively reviewed consecutive 200 CTEPH patients (65±12yrs., Male 43(22%)) who completed BPA procedures from July 2009 to December 2020 and had hemodynamic evaluation after the procedures and extracted the patients with recurrent PH who had a mean pulmonary arterial pressure (mPAP) &lt;25 mm Hg after BPA and developed PH (mPAP ≥25 mm Hg) during follow-up and had a clinical deterioration requiring additional treatment. As risk factors for recurrent PH, we investigated the known risk factors for the development of CTEPH, and the types of oral anticoagulants (warfarin or direct oral anticoagulant). Results: The median follow-up period from final BPA session was 42 [24,62] months. BPA significantly improved mPAP (39±10 to 22±5mmHg, P&lt;0.01) and cardiac output (CO) (3.6±1.1 to 4.1±1.1 L/min, P&lt;0.01). Recurrent PH was observed in 13 of the 200 patients (6.5%) during the follow-up period and the estimated 5-year recurrence rate was 8.9%. The median period from final BPA to recurrence was 20 months [12,47 months], and 6 cases (46%) recurred PH within a year after BPA. In these patients, mPAP deteriorated from 21±2 to 29±5mmHg (P&lt;0.01) but not CO (4.07±0.69 to 3.81±0.50L/min, P=0.46). Of the 13 recurrent PH patients, 9 required additional BPA, and 6 required additional medication. However, the 5-year survival in the recurrent PH and non-recurrent PH groups were comparable (100% and 96.1%, P=0.50). Any risk factors for recurrent PH were not detected. The recurrence rate of PH in those with direct oral anticoagulant (83 cases (42%)) was similar to that in those with warfarin (3.6% and 8.6%, P=0.16). Conclusions: Recurrent PH after BPA is rare and not associated with the known risk factors for CTEPH. The prognosis in the recurrent PH group with additional treatments is similar to that in the non-recurrent group.
Abstract 10787: Carotid Artery Stiffness Mechanisms Associated With End Organ Damage and All-Cause Mortality: The Multi-Ethnic Study of Atherosclerosis (mesa)
Authors: Ryan Pewowaruk, Claudia E Korcarz, Ian H De Boer, Bryan Kestenbaum, Susan R Heckbert, Yacob Tedla, Adam Gepner
Journal: Circulation (2022)

Introduction: Stiff arteries increase the risk of end organ damage to the brain and kidneys. Arterial stiffness can be separated into two main mechanisms: 1) load-dependent stiffening from higher blood pressure and (2) structural stiffening due to remodeling of the vessel wall. The relationship between arterial stiffness mechanisms and end organ damage risk is unknown. Hypothesis: Both stiffness mechanisms will be significantly associated with chronic kidney disease (CKD), dementia, and mortality. Methods: MESA participants with B-mode carotid ultrasound in 2000-2002 were included in this study (n=6147). Carotid pulse wave velocity (cPWV) was calculated to represent total stiffness. Structural stiffness was calculated by adjusting cPWV to a 120/80 BP with participant-specific models. Load dependent (LD) stiffness was the difference of total and structural stiffness. Associations with incident CKD, dementia defined by ICD codes, and mortality were assessed with Cox models adjusted for age, sex, race/ethnicity, education, study site, smoking, pack-years, diabetes, BMI, SBP, non-HDL-C, BP medication, and lipid medication. Results: During 14.3±4.8 years of follow-up, 773 CKD events, 535 dementia events, and 1529 deaths occurred. Total cPWV was associated with mortality (HR 1.04 [1.01-1.08], p=0.02) and dementia (HR 1.06 [1.01 - 1.12], p=0.03). Structural cPWV was significantly associated with mortality (HR 1.04 [1.00 - 1.08], p=0.04) but not CKD (HR 1.00 [0.94-1.05], p=0.86) or dementia (HR 1.06 [0.99-1.13], p=0.06). LD cPWV was associated with CKD (HR 1.38 [1.17 - 1.63], p&lt;0.001) but not mortality (HR 1.11 [0.99-1.25], p=0.07) or dementia (HR 1.14 [0.94-1.38], p=0.19). Conclusions: Structural carotid artery stiffness was significantly associated with all-cause mortality, while LD stiffness was significantly associated with CKD. Total carotid stiffness was associated with incident dementia but LD and structural stiffness mechanisms were not.
Abstract 10073: Acute Ischemic Stroke in Medicare Patients Following Admission for Acute Myocardial Infarction: Analysis From 2019 National Inpatient Sample
Authors: Kamleshun Ramphul, Nomesh Kumar, Renuka Verma, Yogeshwaree Ramphul, Shaheen Sombans, Komal Kumari, Stephanie G Mejias, Petras Lohana, Fnu Arti
Journal: Circulation (2022)

Introduction: With the increasing burden of Acute Myocardial Infarction(AMI) on Medicare, there is a paucity of information on the incidence of Acute Ischemic Stroke(AIS) in those patients and their risk factors. Methods: Patients with a principal diagnosis of AMI covered by Medicare from the 2019 National Inpatient Sample were extracted. Multiple variable regression allowed us to estimate the adjusted odds ratio (aOR) of AIS among patients while acknowledging various possible factors. Results: A total of 378,390 cases of AMI covered by Medicare were found, amongst which 6110 patients,1.6%, also experienced AIS. The mean age of AIS cases was 75.34 years, while it was 74.31 years in non-AIS patients. Patients with AMI are more likely to have a diagnosis of AIS during their hospitalization if they are females (aOR 1.195, 95% CI 1.134-1.260, p&lt;0.01), had a history of alcohol abuse (aOR 1.564, 95% CI 1.346-1.818, p&lt;0.01), peripheral vascular disease (aOR 1.651, 95% CI 1.546-1.764, p&lt;0.01), diabetes (aOR 1.158, 95% CI 1.097-1.222, p&lt;0.01). However, AIS chances are decreased in patients with chronic pulmonary disease (aOR 0.855, 95% CI 0.802-0.912, p&lt;0.01), obese (aOR 0.829, 95% CI 0.770-0.893, p&lt;0.01), smokers (aOR 0.699, 95% CI 0.660-0.739, p&lt;0.01), hyperlipidemia (aOR 0.743, 95% CI 0.703-0.785, p&lt;0.01), ages 60 or less (aOR 0.740, 95% CI 0.662-0.828, p&lt;0.01), and hypertensive (aOR 0.824, 95% CI 0.765-0.889, p&lt;0.01). Blacks (aOR: 1.091, 95% CI 1.002- 1.189, p=0.046) and races other than White, Black, or Hispanic (aOR: 1.353, 95% CI 1.224- 1.495, p&lt;0.01) also showed a higher risk of AIS compared to Whites. AIS also led to an increased risk of mortality (aOR 2.599, 95% CI 2.413-2.801, p&lt;0.01). Conclusions: Several factors influenced the risk of AIS in AMI patients covered by Medicare. More studies are recommended to understand the impact of other possible factors not covered by the NIS, such as medication history.
Abstract 10052: Leadless Pacemaker and Deep Brain Stimulator: Proximity Without Interference
Authors: Shaurya Srivastava, Shakeel Jamal, Sandeep Banga, Ranjan K Thakur
Journal: Circulation (2022)

Introduction: Deep Brain Stimulator (DBS) treatment is a known form of treatment for advanced Parkinson’s disease refractory to medical therapy. With the current aging population, instances where cardiac implantable electronic devices are becoming more frequent. Due to risk of complications from implantation of both devices, literature has recommended keeping a minimum distance of 20cm (or 6in) between the two generators. In this case we have demonstrated a successful leadless pacemaker placement at 37mm apart without any complications. Case Report: 75 year old female with past medical history of essential tremor status post left VIM and VOA/VOP deep brain stimulator placement in 2019 presented to the emergency department with chief complaint of fall secondary to weakness. Electrocardiogram demonstrated Afib with RVR. Heparin was started for anticoagulation as the patient's CHADSVASC score was noted to be 5. Rate control was unsuccessful despite attempts with Metoprolol, digoxin loading, and max use of intravenous Cardizem. Cardioversion was not an option as the patient would need to commit to 4 weeks of uninterrupted therapeutic anticoagulation and be unable to undergo lung biopsy for new found lung mass. Extensive discussion was held with the patient and it was determined to proceed with AV nodal ablation with leadless pacemaker placement. Patient underwent successful placement of the Medtronic MC1VR01 US leadless pacemaker 37mm apart from the prior DBS device. Patient’s heart rate after the procedure remained stable at the lower rate of 80bpm with follow up device check in clinic showing no complications or interference among devices.
Abstract 10014: Work-Related Stress and Ideal Cardiovascular Health: The Multi-Ethnic Study of Atherosclerosis
Authors: Oluseye Ogunmoroti, Olatokunbo Osibogun, Norrina B Allen, Victor Okunrintemi, Yvonne Commodore-Mensah, Roger S Blumenthal, Erin D Michos
Journal: Circulation (2022)

Background: Work-related stress is a psychosocial risk factor linked to a higher risk of adverse health outcomes, especially cardiovascular disease (CVD). However, the association between work-related stress and ideal cardiovascular health (CVH) is not well established. We examined whether work-related stress was negatively associated with favorable CVH in a multi-ethnic population of adults free of CVD at baseline. Methods: We analyzed cross-sectional data of 6,486 men and women aged 45-84 years. Work-related stress was assessed by the presence or absence of ongoing job difficulty and ongoing job difficulty for &gt;6 months. CVH was measured by a scoring system that assigned points to 7 metrics (smoking, physical activity, body mass index, diet, total cholesterol, blood pressure and blood glucose). Each metric had 3 categories: poor (0 points), intermediate (1 point) and ideal (2 points). The total score attainable was 14 points, categorized as inadequate (0-8 points), average (9-10 points) and optimal (11-14 points). We used polytomous logistic regression to examine the association of work-related stress with the CVH score and number of ideal metrics, adjusted for sociodemographic factors. Results: The mean age (SD) was 62 (10) years and 53% were women. Ongoing job difficulty was reported by 14% of participants while 13% reported ongoing job difficulty for &gt;6 months. Participants who reported ongoing job difficulty had 21% and 24% lower odds of having average and optimal CVH scores, respectively (Table). Additionally, the presence of ongoing job difficulty for &gt;6 months was associated with 23% and 24% lower odds of having average and optimal CVH scores, respectively. A similar trend was observed for the association of work-related stress with the number of ideal metrics. Conclusion: Work-related stress was negatively associated with favorable CVH. Stress reduction and CVH promotion programs in the workplace may decrease the incidence of CVD.
Abstract 01: Diagnostic Yield, Safety, and Outcomes with Head-to-Pelvis Sudden Death Computed Tomographic Imaging after Idiopathic Out-of-Hospital Cardiac Arrest: The CT First Cohort Study
Authors: Kelley R Branch, Medley Gatewood, Peter Kudenchuk, Charles Maynard, Michael R Sayre, David Carlbom, Rachael Edwards, Aris Karatasakis, Catherine Counts, Martin Gunn
Journal: Circulation (2022)

Introduction: In survivors of out-of-hospital cardiac arrest without an obvious cause (idiopathic OHCA), diagnosing OHCA causes and complications is challenging in early post-arrest care. Hypothesis: Head-to-pelvis sudden death computerized tomographic CT angiography (SDCT) &lt;6 hours after successful resuscitation will improve the time and diagnostic ability to identify the etiology of OHCA and time-critical diagnoses compared to the standard of care (SOC) alone. Methods: CT FIRST was a prospective observational pre-/post-cohort study of patients successfully resuscitated from OHCA. Inclusion criteria included idiopathic OHCA, age&gt;18 years, clinical stability to undergo SDCT, no known prior cardiomyopathy or obstructive coronary artery disease. SDCT, including ECG-gated thoracic CT, was introduced to the SOC for patients resuscitated from idiopathic OHCA (pre-cohort; years 11/2014-2/2017) and compared to SOC alone (post-cohort, years 1/2011-10/2014). CT scans could be clinically ordered as part of SOC. Primary endpoints were diagnostic SDCT diagnostic yield, time to identify OHCA and time-critical diagnoses, patient safety, and survival to hospital discharge. Results: Baseline characteristics between the SDCT (N=104) and the SOC (N=143) cohorts were similar. A CT scan (head, chest, and/or abdomen) was clinically ordered in 74 (52%) of SOC alone patients. The primary outcomes (Table) demonstrate that compared to SOC alone, SDCT increased the identification of OHCA causes and early diagnosis of time-critical etiologies without an increase in renal insufficiency. SDCT reduced the time to OHCA diagnosis by 78%. Total number of time-critical diagnoses and patient survival to discharge were unchanged between SOC alone and SDCT cohorts. Conclusions: SDCT scanning early after OHCA resuscitation safely improved the efficiency and diagnostic yield for causes of OHCA compared to the standard of care.
Abstract 10: Association Of Race And Medical Emergency Team Evaluations Prior To In Hospital Cardiac Arrest
Authors: Cody-Aaron Gathers, Ryan W Morgan, Jessica Alvey, Ron Reeder, Zachary D Goldberger, Jessica Fowler, Maryam Naim, Amanda O'Halloran, Raina Merchant, Martha Kienzle, Vinay M Nadkarni, Robert A Berg, Robert M Sutton
Journal: Circulation (2022)

Introduction: Racial disparities for in-hospital cardiac arrest (IHCA) outcomes exist. However, whether these are associated with medical emergency team (MET) activation prior to IHCA remain unknown. We aimed to evaluate the association between race and MET activation among patients with physiologic abnormalities (modified early warning score [MEWS] ≥3) prior to IHCA. We hypothesized that MET activation prior to IHCA would be less likely among Black as compared to white patients. In a secondary analysis, we hypothesized that among Black patients, MET activation would be associated with improved IHCA outcomes compared to events without MET activation. Methods: Retrospective cohort study of adults age ≥18 from the AHA Get With The Guidelines®-Resuscitation registry who had an IHCA outside an ICU between 2000 and 2021 with MEWS ≥3 prior to IHCA. A propensity-weighted cohort was constructed to balance confounders between Black and white patients. The association between race (Black vs. white) and MET activation (yes/no) was quantified with weighted multivariable logistic regression. A secondary analysis examined the association between any MET activation and IHCA outcomes among all Black patients. Results: Among 28,123 patients (average age: 68±15; 42% (42 of 100) female) with MEWS ≥3 (average 4±1), 2431 (9% (9 of 100)) had a documented MET activation prior to IHCA. Vitals were measured at a median time of 120 minutes (IQR 60, 210) prior to IHCA. Rates of MET activation were similar between Black and white patients with MEWS ≥3 prior to IHCA (aOR 1.04, CI 0.94-1.15, p=0.45). However, among Black patients, odds of ROSC were higher among patients with a MET activation prior to ICHA compared to those who did not have a MET activation (aOR 1.15, CI 1.03-1.28, p=0.02). Conclusions: Though racial disparities in IHCA outcomes exist, we failed to detect a significant association between race and MET activation for MEWS ≥3 as a potential mechanism for these disparities. Importantly, any MET activation improved IHCA outcomes among Black patients.
Abstract 10116: A Stratified Analysis of the Risk Associated With Low Body Mass Index for Patients After Percutaneous Coronary Intervention
Authors: Takeo Horikoshi, Takamitsu Nakamura, Toru Yoshizaki, Yousuke Watanabe, Jun Nakamura, Manabu Uematsu, Aritaka Makino, Tsuyoshi Kobayashi, Yukio Saito, Jyun-ei Obata, Takao Sawanobori, Hajime Takano, ken umetani, Akinori Watanabe, Tetsuya Asakawa, Akira Sato
Journal: Circulation (2022)

Introduction: The relationship between low body mass index (BMI) and prognostic factors for patients with coronary artery disease, commonly observed in elderly individuals in Japan, is important. Few studies have evaluated the prognosis for patients with low BMI after percutaneous coronary intervention (PCI). We analyzed the risk associated with low BMI for patients after PCI using a multivariable-adjusted model and data from a prospective cohort registry. Methods: This prospective, multicenter registry included 5965 consecutive patients with coronary artery disease who underwent successful PCI. The patients were followed-up clinically for up to 3 years or until the occurrence of major adverse cardiac events. The primary endpoint was defined as a composite of all-cause death and nonfatal myocardial infarction. Results: During the follow-up period, primary events occurred in 639 (10.7%) patients. A risk analysis of the primary endpoint adjusted for the multivariable model showed a significant increase in risk for elderly individuals, underweight individuals[HR 1.43 (95% CI, 1.10-1.85), P &lt; 0.001], those with diabetes mellitus (DM), peripheral artery disease, low left ventricular ejection fraction or acute coronary syndrome (ACS), and smokers. A stratified adjusted risk analysis based on BMI levels showed that the risk associated with underweight status was significantly pronounced for male patients, those aged 60-74 years, those with DM or ACS. Conclusions: Underweight patients with several risk factors were at significantly increased risk after PCI. Furthermore, the risk associated with low BMI was significantly more pronounced for men, individuals aged 60-74 years, patients with DM or ACS.
Abstract 09: Readmission Risk And The Role Of Racial Residential Segregation Following Out-of-hospital Cardiac Arrest Among Medicare Beneficiaries
Authors: Ethan Abbott, David Buckler, Jesse Hsu, Benjamin Abella, Brendan G Carr, alexis zebrowski
Journal: Circulation (2022)

Introduction: Among out-of-hospital cardiac arrest (OHCA) survivors, high rates of mortality and readmissions have been reported after discharge. Racial residential segregation, a result of longstanding US institutional racism, has been associated with worse health outcomes across multiple conditions, but its relationship to readmission risk for OHCA is unknown. We investigated if the index of concentration at the extremes (ICE) is associated with increased risk of readmission for Medicare beneficiaries after survival from index hospitalization for OHCA. Methods: Using age-eligible Medicare fee-for-service claims from 2013-2015, we identified beneficiaries with a primary OHCA diagnosis (using ICD-CM diagnosis codes) who survived to discharge. The primary predictors were three ICE measures (race, income, and racialized income) calculated at the ZIP code level and binned into quintiles. The primary outcome was all-cause readmission after discharge from inpatient OHCA hospitalization. Competing risks regression models were fitted with a frailty term with readmission as the event of interest and mortality prior to readmission as the competing event, while accounting for beneficiary demographics, comorbidities, length of stay, and cardiac procedures. Results: We identified 200,509 OHCA claims; 29,847 (14.8%) survived to discharge. Mean beneficiary age was 75 years (SD 8), 40% were female, 79% White, and 15% Black. Within 30 days of discharge 8839 (29.6%) had died and 12075 (40%) were readmitted; congestive heart failure was the leading cause of readmission (12.5 %). In univariate analysis, we found a decreased risk of readmission in the more racially and economically privileged quintiles (Q2-Q5) of ICE race (HR 0.87-0.99) and ICE racialized income measures (HR 0.91-0.96) as compared to reference (Q1) but this was not significant across all quintiles. In fully adjusted competing risk regression models, we did not find a significant association with risk of readmission and measures of residential segregation. Conclusion: Measures of racial residential segregation are associated with increased risk of readmission among Medicare beneficiaries residing in less privileged ZIP codes, but not present after adjusting for important covariates.